Friday
May252018

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition
 

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

Insurers, small businesses praise move to delay Obamacare health insurance tax

After logging a victory in Congress to suspend a controversial Obamacare tax beginning in 2019, health insurers and small businesses are now setting their sights on 2020.

Washington Examiner

Thursday, May 24, 2018

 

Pfizer Settles Kickback Case Related To Copay Assistance For $24M

Pfizer will pay the government nearly $24 million as part of a settlement to resolve allegations that it funneled money through a foundation resulting in illegal kickbacks.

Kaiser Health News

Thursday, May 24, 2018

 

Drugmakers Blamed For Blocking Generics Have Jacked Up Prices And Cost U.S. Billions

Makers of brand-name drugs called out by the Trump administration for potentially stalling generic competition have hiked their prices by double-digit percentages since 2012 and cost Medicare and Medicaid nearly $12 billion in 2016, a Kaiser Health News analysis has found.

Kaiser Health News

Wednesday, May 23, 2018

 

Insurance Consolidation May Soon Include Hospitals, Create Powerhouses

The continued market consolidation and efforts to create an “all-in-one” approach to healthcare insurance customers may lead to carriers acquiring large hospital networks, particularly if the CVS-Aetna transaction proves to be successful and profitable, one analyst says.

HealthLeaders Media

Wednesday, May 23, 2018

 

Kaiser Permanente commits $200M to reduce homelessness

Kaiser Permanente is teaming up with mayors of a number of American cities to fight housing insecurity and homelessness. The Oakland, California-based integrated health system said late last week it will invest up to $200 million.

Healthcare Dive

Tuesday, May 22, 2018

 

 

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

 
Wednesday
May232018

Too Many Poor Excuses

Too Many Poor Excuses
 

By Kim Bellard, May 23, 2018

 

I am so tired of reading yet another story about how we — Americans — cannot afford things. Not luxury item. Increasingly, it seems like too many of us can’t afford what most people would consider basics — food, housing, child care, transportation.

 

And health care, of course.

 

new study by the United Way ALICE Project found that 51 million households can’t afford a basic monthly budget that includes food, housing, health care, child care, and a cell phone. That is 43% of all U.S. households.

 

ALICE stands for Assets Limited, Income Constrained, Employed. Of the 51 million households, two-thirds are ALICE ones. These are working households that, in a prior era, might have been thought of as middle class.

 

Now they are living paycheck to paycheck, and fearing sudden expenses — like an unexpected health care bills. Maybe they can’t afford their insulin, their inhalers, or their epipens anymore. And, of course, God forbid they end up in the emergency room or get out-of-network care.

 

Indeed, a hospital stay may result in a permanent reduction in income, even if you have insurance, according to a study released earlier this year. We shouldn’t be surprised that the Commonwealth Fund recently found that the percentage of Americans who feel confident they can afford the health care they need continues to fall. Only 62% re very or somewhat confident, down from 69% just three years ago. Twenty-four percent reported health care has become harder to afford over the last year.

 

Another new study found that 40% of us skipped a recommended test or treatment due to cost, and 44% skipped seeing a doctor when sick or injured due to concerns about costs. More feared the cost of a serious illness than they did the serious illness itself.

 

That is seriously wrong.

 

And there are no signs of anything improving. The number of uninsured is rising again. Actions by the Trump Administration to undermine the ACA exchange markets are estimated to have drastic increases on health insurance premiums — potentially jumping by 35% to 94% over the next three years. Plus, HHS has proposed rules for so-called short-term health insurance policies that the CMS

 

Actuary says will simply increase costs for everyone else, not to mention that those “covered” under those policies will find that coverage to be skimpy if/when they need it.

 

This all adds up. Kaiser Health News reports that, in addition to bankruptcies due to health care bills, nearly 40% of adults under 65 have had their credit scores lowered due to medical debts. A 2014 Consumer Financial Protection Bureau report found that almost 20% of credit reports had at least one medical collection account listed.

 

The sad truth is that only 39% of Americans say they could handle an unexpected expense of even $1,000 — and 34% had had a major unexpected expense over the past year. Not surprisingly, we are doing a terrible job saving for retirement. Increasingly, we’re both saying we’ll have to rely on Social Security for our retirement income, while lamenting that we’re not very confident it will be there when we need it.

 

These problems are not about our having enough money. We do. They are not just problems for “poor people.” They are problems for the majority of us. These are problems of priorities, and somewhere along the way our have gotten screwed up.

 

We’re making too many poor excuses for not doing more and for not doing better. It’s time to stop.
 
This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

 
Friday
May182018

Six Things To Know From Deloitte Research on Health Plan Government Business

Six Things To Know From Deloitte Research on Health Plan Government Business
 

By Clive Riddle, May 18, 2018

 

This week, Deloitte Center for Health Solutions’ Andreea Balan-Cohen, Ph.D., and Maulesh Shukla gave a presentation on Medicare Advantage and Medicaid Managed Care Trends: Deloitte Research in a live HealthcareWebSummit event.

 

The basis for their discussion was Deloitte Center for Health Solutions analysis of financial performance trends in the US fully insured health plans market between 2011 and 2016. This research series was divided into three chapters: Chapter 1, published in December 2017, provided summary observations on overarching developments in the market. Chapter 2, published in March 2018, focused on trends in health plan government programs, specifically Medicare Advantage and Medicaid managed care. Chapter 3, forthcoming later this month, will focus on trends in the commercial individual and commercial group lines of business.

 

Here’s six key findings they shared on U.S. health plans’ government business:

1.     Government programs accounted for a large and growing share of health plan revenue and underwriting gains.

2.     The Medicare Advantage business experienced significant top-line growth and bottom-line volatility, including a notable decline in underwriting performance in 2014 and 2015.

3.     In Medicaid managed care, aggregate plan revenue increased steadily between 2011 and 2016, and underwriting performance grew impressively before retrenching in 2016.

4.     The largest Medicare and Medicaid plans by national revenue captured a disproportionate and growing share of industry underwriting gains.

5.     Medicare Advantage performance variation widened beginning in 2014; smaller plans and newer entrants experienced substantial headwinds.

6.     Medicaid managed care markets exhibited widening performance variation at the company and state levels beginning in 2014.

 
Thursday
May172018

Medication Nonadherence: Data and Analytics Can Make an Impact

By Claire Thayer, May 16, 2018

Over two-thirds of hospital readmissions are directly due to medication nonadherence.  Many factors contribute to patients not taking their medications, including fear of side effects, out-of-pocket costs, and misunderstanding intended use.  Interventions targeted at understanding the underlying causes on nonadherence are critical to improving chronic disease outcomes.  Successful interventions include: educating patients on purpose and benefits of treatment regimen, reducing barriers to obtain medication, as well as use of health IT tools to improve decision making and communication during and after office visits. 

This weeks’ edition of the MCOL infoGraphoid, co-sponsored by DST Health, explores how data and analytics can provide insight to drive behavior change to improve adherence.

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Friday
May112018

The Disconnect with Consumers and Health Plan Costs

The Disconnect with Consumers and Health Plan Costs
 

By Clive Riddle, May 11, 2018

 

eHealth this week released a new eleven page report: Costs and Consequences in the ACA Market: A Survey of Individual and Family Health Insurance Consumers, presenting findings from more than 1,700 consumers who purchased their ACA-compliant plans via eHealth that included:  (1) “Consumers’ idea of a fair price is hard to find in today’s market;” (2) Policyholders aren’t willing to pay extra for key ACA benefits;” and (3) “Voters are bringing health care frustrations to the mid-term elections this fall,” (66% said it was one of their top three issues.)

 

Consistent with a number of previous studies, there is a significant disconnect between consumers sense of where healthcare prices should be in the market, and what they actually are. Health reports that the average individual monthly premium cost during the last open enrollment was $400,  Only 3% surveyed felt $400+ was a fair price. Only 9% felt $300+ was fair. Only 25% felt $200+ was fair. So what is fair? 38% felt premiums should be $100 or less. Another 36% felt $200 or less was fair.

 

The disconnect carries over consumer sense of the value of specific benefits. 61% want mental health benefits, 60% want maternity care and 55% want birth control coverage (which are all ACA required), but only 25%, 24% and 16% respectively, want to pay for them. Even emergency room benefits experience this disconnect: 80% want the benefit and 54% are willing to pay for it.

 

ACA compliant HDHPs are prevalent in the ACA marketplace, and continue to gain the large group environment as well. Benefitfocus this week released a new eleven page survey report: The State of Employee Benefits 2018 - Industry Edition that examined benefit trends for four sectors: education, health care, manufacturing and retail, with an emphasis on examining the impact of HDHPs in each sector.

 

Benefitfocus found that regarding HDHP prevalence by sector:

·         Education: 50% of employers offer HDHPs compared to 23% in 2016.

·         Healthcare: 73%% of employers offer HDHPs compared to 56% in 2016.

·         Manufacturing: 88%% of employers offer HDHPs compared to 54% in 2016.

·         Retail: 76%% of employers offer HDHPs compared to 55% in 2016.

·         All Industries: Healthcare: 70%% of employers offer HDHPs compared to 58% in 2016.

 

When large employers offer other type plans and HDHPs side by side (many employers do not offer both), the HDHP employee enrollment rates by sector were: Education: 34% (30% in 2016); Healthcare: 27% (23% in 2016); Manufacturing: 29% (46% in 2016); Retail: 40% (27% in 2016) and All Industries: 35% (40% in 2016).

 

What would drive such different results by sector? Employee premium HDHP contributions compared to last year decreased 27% in Education, increased 4% in healthcare, increased 46% in manufacturing, increased 20% in retail, and increased 4% overall for all industries.

 

So just as in the individual marketplace, much comes down to price, even though there is a disconnect in the value that price reflects.